Provider Demographics
NPI:1205224748
Name:HATCHER, RYAN BROCK (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BROCK
Last Name:HATCHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5806
Mailing Address - Country:US
Mailing Address - Phone:563-542-2596
Mailing Address - Fax:319-208-9456
Practice Address - Street 1:145 W BURLINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1914
Practice Address - Country:US
Practice Address - Phone:319-208-9456
Practice Address - Fax:319-208-9456
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0220750Medicaid